IBUPROFEN

Ibuprofen was developed as a safer alternative to aspirin and released in the late 1960s as a treatment for rheumatoid arthritis. Initially sold as a prescription drug, it became available in an OTC form in the early 1980s. People often take it for pain and inflammation as well as fever.

CHEMICAL NAME

2-[4-(2-methylpropyl)phenyl]propanoic acid

MEDICINES

In the early 1950s, researchers searching for new drugs to treat rheumatoid arthritis initially rejected the group of compounds that included ibuprofen because of concerns about toxicity. But then ibuprofen was found to be effective and well tolerated. It is far safer than aspirin or acetaminophen with respect to overdosage.

HOW IT WORKS

Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID). Like other NSAIDS, it decreases synthesis of prostaglandins by inhibiting the enzyme cyclooxygenase (COX), which leads to decreased levels of pain and inflammation.

SIDE EFFECTS

Among the most frequent—and most frequently underestimated—side effects of ibuprofen are gastrointestinal problems, which can include nausea, vomiting, and hemorrhaging. Gastrointestinal specialists consider nonsteroidal antiinflammatory medicines to be one of the most significant causes of potentially life-threatening ulcers. Particularly in patients over the age of 60, there is an increased risk of fatal intestinal bleeding. Another problem affects amateur and professional athletes. Surveys have shown that up to 50% of marathon runners take ibuprofen before a race in the belief that it will improve their endurance and lessen their pain. This is a completely senseless and dangerous step in their efforts to boost performance. Studies show that ibuprofen produces neither of the desired effects. On the contrary: It increases some of the undesired side effects in a race, including decreased intestinal blood flow during

marathon. As a result, harmful bacteria can more easily gain access to the bloodstream, where they can poison the athlete.

INTERACTIONS

When ibuprofen is taken in combination with acetylsalicylic acid (aspirin), which acts as a blood thinner, the risk of heart attack actually increases. In such a combination, ibuprofen lowers the antiplatelet properties of aspirin. In addition, ibuprofen alters the effect of the following medicines when taken together with them: digoxin (for heart failure), lithium (for depression), methotrexate (immunosuppressive drug), and phenytoin (an anticonvulsant). The problem: Raising the blood levels of the active ingredients can result in toxicity.

PROPER USE

Ibuprofen is taken primarily for two major effects: In doses between 200 mg and 800 mg it lowers fever and reduces pain. An anti-inflammatory effect is observed at doses above 2,400 mg per day. For patients (over the age of 12) who are self-medicating, 2,400 mg of ibuprofen per day is also the upper limit. An individual dose for an adult should not exceed 800 mg. In general: Except on a doctor’s orders, patients should not take ibuprofen for more than four days in a row. Side effects can be lessened by taking a stomach protector (proton pump inhibitor) such as pantoprazole. This, too, should not be done unless directed by a physician.